Frailty, multimorbidity and functional status as predictors for health outcomes of acute psychiatric hospitalisation in older adults.

Objectives: Frailty, multimorbidity and functional decline predict adverse health outcomes in community dwelling older people and older patients in general hospitals. This study investigates whether these characteristics separately are independent predictors of health outcomes of acute psychiatric hospitalization.Methods: Observational study in a prospectively sampled cohort of older patients, consecutively admitted to a psychiatric hospital. On admission we assessed frailty (Frailty Index and walking speed); multimorbidity (Cumulative Index Rating Scale Geriatrics (CIRS-G)) and functional status (Barthel Index). We used the Clinical Global Impressions of Improvement scale (CGI-I) as the psychiatric outcome measure, and dichotomized discharge destination as overall outcome measure: favourable (able to return home or previous care level) or adverse (death, or move to higher level of residential care).Results: We included 120 patients, 74.6 years (±7.8). 52.5% of the patients was frail (FI ≥0.25). The mean level of the CIRS-G was 13.5 (5.4). Mean CGI-I at discharge was 2.8 (± 1.0), indicating moderate improvement in the psychiatric outcome. Neither FI, CIRS-G, nor Barthel scores were, independent of age, sex and diagnosis, associated with the CGI-I. FI was predictive for adverse discharge destination (OR 1.91, 95%CI 1.09-3.37 per 0.1), as were higher CIRS-G (OR 1.19 95%CI 1.06-1.34, per point) and lower walking speed (OR 1.35 95%CI 1.06-1.72 per 0.1 m/s).Conclusions: Half of our patients were frail and had a high level of multimorbidity. The FI, walking speed and multimorbidity did not predict improvement of psychiatric symptoms at discharge, but independently helped to predict adverse discharge destination.

Diastolic blood pressure drop after standing as a clinical sign for increased mortality in older falls clinic patients.

BACKGROUND: Orthostatic hypotension, postprandial hypotension, and carotid sinus hypersensitivity are hypotensive syndromes with high prevalence in older people. However, their pathophysiology and prognostic significance remain largely unknown. METHODS: In a retrospective cohort study of 313 consecutive patients visiting our falls outpatient clinic, we examined the clustering of orthostatic hypotension, postprandial hypotension, and carotid sinus hypersensitivity in the same patients, which might reflect a shared similar pathophysiology. The value of hypotensive syndrome presence and the degree of blood pressure decline as prognostic indicators for mortality were assessed using Cox proportional hazards analyses. RESULTS: In 313 patients (mean age 78.7 ±â€Š8.0 years), 168 of 309 (54%), 175 of 302 (58%), and 143 of 272 (53%) were diagnosed with orthostatic hypotension, postprandial hypotension, and sinus carotid hypersensitivity, respectively. There was no clustering of the hypotensive syndromes. During a median follow-up of 23.0 months, 58 (19%) patients died. Orthostatic hypotension, but not postprandial hypotension or carotid sinus hypersensitivity, predicted mortality [hazard ratio 1.97; 95% confidence interval (CI) 1.11-3.47]. After adjusting for age, comorbidity and other baseline characteristics, this relationship was no longer significant. However, orthostatic hypotension with severe diastolic blood pressure decline of at least 20 mmHg remained a powerful independent predictor of mortality (hazard ratio 2.50; 95% CI 1.20-5.22). CONCLUSIONS: In falls clinic patients, hypotensive syndromes did not cluster and did not independently predict mortality. However, orthostatic hypotension with severe diastolic blood pressure decline was a powerful independent predictor of mortality and might be used prognostically as an easily available cardiovascular sign of increased mortality risk.